UWorld Urinary/Renal & Integumentary- Child Health

The nurse is caring for a 7-year-old client with acute glomerulonephritis. Which of the following is a priority for the nurse to monitor?

1. Blood pressure - Severe hypertension from fluid volume excess may develop suddenly and must be identified early. Monitoring and control of hypertension are a priority to prevent further progression of kidney injury, development of hypertensive encephalopathy, and pulmonary edema (Option 1)

The triage nurse receives a phone call from the parent of a child who has just spilled boiling water on the arm. Which of the following instructions by the nurse are appropriate for initial burn management? Select all that apply. Burns are a leading cause of accidental injuries and mortality in children and may lead to significant long-term complications depending on the severity of the burn. Management begins as soon as the injury occurs and focuses on minimizing tissue damage, reducing the risk of hypothermia, and preventing infection. The priority action is to stop the burning process and to ensure that the child is not exhibiting signs of impending airway compromise. Topical ointments, oils, and medications should be avoided because they may intensify the injury.

1. "Administer acetaminophen or ibuprofen for pain control." - Administer acetaminophen or ibuprofen for pain control (Option 1). 3. "Briefly apply cool water to the arm until the pain lessens." - Briefly run cool or lukewarm water over the burn to relieve pain and stop the burning process. Avoid directly applying ice or using cold water, which may decrease oxygenation and increase tissue damage (Option 3). 4. "Lightly cover the area with a nonadhesive, clean bandage." - Lightly cover the burn area with a nonadhesive bandage to minimize infection risk 5. "Remove clothing around the burn that is not stuck to the skin." - Quickly remove clothing and jewelry around the burn area to avoid constriction during the initial edematous phase. A health care provider will remove any clothing that is stuck to the burn (Option 5).

The nurse reinforces teaching for the parents of a child with impetigo. Which of the following statements by a parent indicates correct understanding of teaching? Select all that apply Impetigo is a highly contagious bacterial skin infection, most commonly occurring in children during hot, humid weather. Impetigo is characterized by itchy, burning, red pustules that rupture to form honey-colored crusts. When treated with antibiotic ointment and/or oral antibiotics, lesions are no longer contagious after 24-48 hours and typically heal within a week. Without antibiotics, impetigo typically resolves within 2-3 weeks but remains highly contagious until lesions heal. Impetigo lesions should be soaked with warm water, saline, or Burow's solution (a skin-soothing astringent) and gently cleansed with mild antibacterial soap before applying antibiotic ointment. This helps remove infected crusts and reduce irritation. Alcohol is irritative and should be avoided.

1. "I should wash my hands before and after touching the infected area." 3. "I will separate my child's towels from other laundry and wash them with hot water." 4. "My child's fingernails should be kept short and well-filed." 5. "The infection could easily spread to other children who come in contact with my child." To care for and decrease transmission of impetigo, interventions include: - Performing handwashing before and after touching the infected area (Option 1) - Isolating the infected person's clothing and linens and washing them in hot water (Option 3) - Keeping the infected person's fingernails short and clean to prevent bacteria from collecting under them and to deter scratching (Option 4) - Avoiding close contact with others for 24-48 hours after initiation of antibiotic therapy (Option 5) - Keeping the infected area covered with gauze when in contact with others (eg, while at school)

The nurse has taught the parents of a 6-year-old client with nephrotic syndrome. Which of the following statements by the parents would require follow-up? Nephrotic syndrome usually happens when the glomeruli are inflamed, allowing too much protein to leak from your blood into your urine. Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine

1. "I will encourage my child to play with other children." - The loss of immunoglobulins causes increased susceptibility to infection. Parents should minimize the risk for infection by limiting the client's physical contact with others during periods of relapse (Option 1). Nephrotic syndrome, an autoimmune disease, affects children age 2-7 and is characterized by increased permeability of the glomerulus to proteins (eg, albumin, immunoglobulins). This results in hypoalbuminemia, lowering the plasma oncotic pressure; therefore, it allows fluids to exit the vascular space more easily and remain in the tissues. Clinical manifestations include generalized edema, weight gain, loss of appetite (from ascites), and decreased urine output. Nephrotic syndrome is an autoimmune disease characterized by massive proteinuria, edema, and hypoalbuminemia. Consume a low sodium diet

Four children are seen in the school nurse's office. Which client condition is most concerning to the nurse? 1. 5-year-old with a red rash with yellow drainage and honey-colored crusting around the nose and mouth (56%) 2.6-year-old with multiple small, red, painful, pimple-like lesions on both legs after playing outdoors (13%) 3.9-year-old with an itchy vesicular rash on the arms that is oozing serous fluid after a hiking trip (25%) 4.10-year-old with an itchy rash confined to the creases of the elbows and the back of the knees bilaterally Multiple small, red, and painful lesions that resemble pimples (ie, pustules) are likely insect bites or stings and are not contagious. (Option 3) An itchy vesicular rash that is oozing serous fluid following an outdoor activity is most likely allergic contact dermatitis caused by poison ivy. The rash itself is not contagious, but anything that has been in contact with the allergen should be cleansed to prevent further exposure. An intensely itchy rash on the bilateral flexural creases (eg, elbows, knees) indicates atopic dermatitis (ie, eczema), a noncontagious chronic skin disorder characterized by pruritus, erythema, and dry skin.

1. 5-year-old with a red rash with yellow drainage and honey-colored crusting around the nose and mouth (56%) A rash with a red base and honey-colored crusts indicates impetigo, a highly contagious bacterial infection. Impetigo is passed via direct or indirect contact (eg, shared toys) and most commonly affects children, especially those with close contact in school settings. Contact precautions should be used in health care settings to prevent transmission of impetigo (Option 1).

Which condition does the nurse suspect? Acute postinfectious glomerulonephritis (APGN) is an immune reaction that follows a preceding skin or upper respiratory infection, most commonly a streptococcal infection. Antibodies respond to the infectious antigens, forming an immune complex that becomes trapped in the capillary loop of the glomeruli. Cellular proliferation leads to swelling and infiltration of leukocytes, which then reduces renal blood flow and causes a decrease in the glomerular filtration rate. Decreased renal filtration causes excessive sodium retention and water accumulation, leading to hypertension and periorbital and lower extremity edema.

1. Acute postinfectious glomerulonephritis Laboratory findings associated with APGN include increased serum BUN, increased serum creatinine, increased urine protein, and the presence of RBC casts in urine due to impaired glomerular filtration. After reviewing the client's laboratory findings, the nurse should suspect APGN (Option 1). The nurse should anticipate supportive management and symptom relief to minimize complications (eg, correcting fluid balance, hypertension).

Drag words from the choices below to fill in the blanks. The client is diagnosed with acute postinfectious glomerulonephritis. The client is most at risk for

1. Cerebral edema 2. Pulmonary edema In addition to clients with acute kidney injury (AKI), those with acute postinfectious glomerulonephritis (APGN) are most at risk for cerebral edema and pulmonary edema. APGN causes decreased glomerular filtration (ie, AKI), resulting in systemic sodium and fluid retention. Pulmonary edema can occur as fluid backs up into the systemic circulation and the lungs. A rapid increase in blood pressure can result in hypertensive encephalopathy (ie, cerebral edema [brain swelling]).

A nurse is reviewing the laboratory values for a 3-year-old client with nephrotic syndrome. The nurse interprets the results to most clearly reflect which physiologic process related to nephrotic syndrome? Click on the exhibit button for additional information. he most common cause of nephrotic syndrome in children is minimal change nephrotic syndrome, which is generally considered idiopathic. Less common secondary causes may be related to systemic disease or infection, such as glomerulonephritis, drug toxicity, or acquired immunodeficiency syndrome. (normal total cholesterol <200 mg/dL [5.2 mmol/L]) low serum albumin (normal 3.5-5.0 g/dL [35-50 g/L])

1. Glomerular injury Nephrotic syndrome is a collection of symptoms resulting from various causes of glomerular injury. Below are the 4 classic manifestations of nephrotic syndrome: - Massive proteinuria - caused by increased glomerular permeability - Hypoalbuminemia - resulting from excess protein loss in the urine - Edema - specifically periorbital and peripheral edema and ascites; caused by low serum protein and albumin as fluid is pulled into interstitial spaces and body cavities - Hyperlipidemia - related to increased compensatory protein and lipid production by the liver Additional symptoms include decreased urine output, fatigue, pallor, and weight gain.

The client is admitted to the pediatric unit with a diagnosis of acute postinfectious glomerulonephritis. The nurse understands that the client is most likely experiencing _____ and should receive ______ and should receive

1. Hypertensive encephalopathy 2. Antihypertensives A complication of acute postinfectious glomerulonephritis (APGN) is hypertensive encephalopathy. APGN causes decreased glomerular filtration resulting in systemic sodium retention that can lead to edema and hypertension. An acute raise in blood pressure can result in ineffective autoregulation of cerebral blood flow, which causes hypertensive encephalopathy (ie, cerebral edema). he nurse should recognize symptoms of hypertensive encephalopathy (eg, hypertension with headache, nausea, vomiting, altered mental status) and provide prompt treatment with antihypertensives to avoid progression to seizures or coma.

The nurse understands that the client is most likely experiencing ____ and should receive ______

1. Impetigo 2. An antibiotic The client's erythematous rash with honey-colored crusting on and around the nose and mouth is consistent with a diagnosis of impetigo. Impetigo is caused by either Streptococcal pyogenes or Staphylococcal aureus bacteria. Preferred treatment for localized infection is topical antibiotics (eg, mupirocin); however, for severe or systemic manifestations, oral antibiotics (eg, cephalexin) may be indicated. Adherence to antibiotic therapy is important to prevent transmission and avoid complications (eg, poststreptococcal glomerulonephritis, rheumatic fever).

The nurse is preparing the client for discharge. Which of the following statements by the parent indicate a correct understanding of the teaching? Select all that apply.

1."I will contact the health care provider immediately if my child experiences any vision changes, such as blurriness." - Notifying the health care provider of any changes in vision (due to hypertension), darkening urine, or decreased urinary output; this can indicate unresolved APGN (Option 1). 2."I will schedule a follow-up visit for a urinalysis and blood pressure check." - Ensuring that the client and family are aware of follow-up visits and repeat urinalyses to ensure hypertension is controlled and kidney function is improving (Option 2). 3."My child may notice small amounts of blood in the urine for several weeks." -Providing anticipatory guidance for hematuria, which may persist for weeks to months after APGN has resolved (Option 3). 4."My child should avoid exposure to friends and family who show signs of an upper respiratory infection." - Avoiding friends and family members who are experiencing signs of upper respiratory infections because clients experiencing renal impairment are at increased risk for infection. The family should monitor for fever and limit visitors (Option 4).

The nurse is discussing management of nocturnal enuresis with the parent of a 10-year-old client who has had little response to behavioral interventions. The parent tells the nurse, "My child wants to go to overnight camp in several months but is afraid of being teased by other children if an accident occurs." Which of the following responses would be most appropriate for the nurse to make?

2. "We can ask your child's health care provider about trying a medication that may be helpful." - Pharmacological interventions are often used as second-line treatment for nocturnal enuresis in children age >5; this is initiated when there has been little or no response to behavioral approaches and/or when short-term improvement of enuresis is desired for attending sleepovers or overnight camp (Option 2). Desmopressin is a medication that can be used to decrease urine production during sleep. A trial period of the medication is performed for at least 6 weeks to determine the appropriate medication dose and effectiveness of therapy. Parents should be cautioned that there is a risk for relapse once the medication is discontinued. Wearing disposable training pants could embarrass the child at overnight camp as well as discourage motivation to get up and void during the night.

The client has been diagnosed with group A Streptococcus pyogenes impetigo. Which of the following instructions should the nurse include when providing home care teaching to the client's parents? Select all that apply

2. Avoid sharing linens -Avoid sharing linens or personal items that could spread the infection. All linens, towels, and clothes should be washed and dried on high heat (Option 2). Contact precautions and home isolation are recommended. 4.Keep the child's nails short -Keep the client's fingernails short to control scratching. Bacteria can accumulate under longer nails, be transferred to, and infect other areas of the body and/or other individuals. In addition, itching should be controlled to prevent a secondary infection (Option 4). 5.Soak the lesions and remove crusts with soap and water -A clean washcloth should be used to wash the affected lesions each time to avoid transferring bacteria back to the skin. Prescribed antibiotic ointment should be applied after crusts are removed to improve the absorption. A cotton applicator should be used, and hands must be washed before and after the application Impetigo lesions should be covered (eg, with gauze), not left open to air. Covering the lesions can discourage scratching and prevent direct contact with the infected areas, which decreases transmission and spread to other areas of the body. The client is considered contagious until 24-48 hours of antibiotic therapy has been completed.

A client diagnosed with acute glomerulonephritis has pitting edema in both lower extremities, blood pressure of 170/80 mm Hg, and proteinuria. When developing a plan of care for this client, the nurse should include which most accurate indicator of fluid loss or gain?

2. Daily weight measurements The most accurate indicator of fluid loss or gain in an acutely ill client is weight, as accurate intake and output and assessment of insensible losses may be difficult (Option 3). A 2.2-lb (1-kg) weight gain is equal to 1,000 mL of retained fluid.

What question is most appropriate for the nurse to ask the client's caregiver? Acute postinfectious glomerulonephritis (APGN) is an immune reaction that occurs approximately 2-3 weeks following a skin or upper respiratory infection, most commonly a streptococcal infection. Antibodies respond to the infectious antigens, forming an immune complex that becomes trapped in the capillary loop of the glomeruli. Cellular proliferation leads to swelling and infiltration of leukocytes, which then reduces renal blood flow and causes a decrease in the glomerular filtration rate. Decreased renal filtration causes excessive sodium retention and water accumulation, leading to hypertension and periorbital and lower extremity edema. Family history of cancer, constipation, and risk factors for intestinal obstruction (eg, prior surgery) are not a priority given the periorbital and ankle edema, which indicate glomerular disease in this client. Symptoms of APGN include periorbital edema, abdominal distension, lower extremity edema, hypertension, decreased urine output, and hematuria.

2. Have you noticed any changes with your child's urine?" The client's headache, periorbital/ankle edema, and abdominal distension should alert the nurse to possible APGN given the client's recent streptococcal impetigo infection. When APGN is suspected, the nurse should assess for additional findings such as changes in urine amount and color because APGN can cause decreased urine production and hematuria (ie, dark, cola- or tea-colored urine A client with signs of APGN should be examined by a health care provider immediately because APGN often requires hospitalization to monitor for potential complications (eg, acute kidney injury, pulmonary edema, hypertensive encephalopathy).

Which finding requires priority follow-up? Edema; hypertension; decreased urine output; and dark, cola-colored urine following an untreated sore throat (likely streptococcal infection) are indications of renal impairment, which requires further investigation. Acute postinfectious glomerulonephritis is a common, noninfectious kidney disease that can occur when immune complexes are deposited in the glomeruli following infection (eg, throat, skin) with certain strains of bacteria (eg, group A beta-hemolytic Streptococcus Dark, cola- or tea-colored urine indicates gross hematuria that is concerning for glomerular injury.

3. Hypertension - After reviewing the client's clinical data, the nurse should prioritize management of hypertension to avoid hypertensive encephalopathy, pulmonary edema, and permanent kidney damage (Option 3) After hypertension is controlled, the client's periorbital and lower extremity edema may be managed using appropriate diuretic therapy as well as sodium and water restrictions.

The nurse is admitting a 4-year-old diagnosed with Wilms tumor. The child is scheduled for a right nephrectomy in the morning. Which action is a priority in the preoperative care plan? Some clients may have hypertension due to excess production of renin, and this will require monitoring. However, it is not as important as ensuring that the abdomen is not palpated.

3. Instructions not to palpate the abdomen Wilms tumor (nephroblastoma) is a kidney tumor that usually occurs in children age <5. Most often it involves only one kidney, and the prognosis is good if the tumor has not metastasized. Wilms tumor is usually diagnosed after caregivers observe an unusual contour in the child's abdomen. Once the diagnosis is suspected or confirmed, the abdomen should not be palpated, as this can disrupt the encapsulated tumor. It is important to post the sign "DO NOT PALPATE ABDOMEN" at the bedside. It is also essential that the child be handled carefully during bathing.

The nurse is assisting the client to select food choices for lunch. Which of the following choices would be appropriate for the client's dietary needs? Select all that apply.

3. Plain yogurt with oats, honey, and blueberries 5. Wheat toast with unsalted peanut butter and banana A client with acute postinfectious glomerulonephritis (APGN) should be instructed to follow a low-sodium diet if experiencing edema and hypertension. Foods high in sodium can cause fluid retention and worsen hypertension. Fresh fruits and vegetables (eg, blueberries, banana), whole grain breads and cereals (eg, oats, wheat toast), and unsalted spreads and sweeteners (eg, unsalted peanut butter, honey) are typically low in sodium and would be appropriate nutritional choices for a client with APGN (Options 3 and 5).

The nurse assesses a pediatric client who was diagnosed with diarrhea caused by Escherichia coli. The nurse is most concerned with which finding? Hemolytic uremic syndrome (HUS) is a life-threatening complication of Escherichia coli diarrhea. Clinical features include anemia (pallor), low platelets (petechiae and purpura), and acute kidney injury (low urine output). Blood-streaked stool due to intestinal irritation is a common symptom associated with this illness Dry mucous membranes are a sign of dehydration, a common complication of any persistent diarrhea. D Fruit juices are discouraged in acute diarrhea as they have high sugar (osmolality) and low electrolyte content. Continuing the client's normal diet (solid foods) is encouraged as it shortens the duration and severity of the diarrhea.

4. Petechiae noted on the trunk Hemolytic uremic syndrome (HUS) is a life-threatening complication of Escherichia coli diarrhea and results in red cell hemolysis, low platelets, and acute kidney injury. Hemolysis results in anemia, and low platelets manifest as petechiae or purpura. Therefore, the presence of petechiae in this client could indicate underlying HUS and needs further assessment (Option 4).

For each characteristic below, click to specify if the characteristic is consistent with the disease process of allergic contact dermatitis, herpes simplex type 1, or impetigo. Each characteristic may support more than one disease process.

Allergic Contact Dermatitis: erythema, blisters or vesicles, -Allergic contact dermatitis is a type IV hypersensitivity reaction that manifests as a pruritic, painful, erythematous rash in an area exposed to an allergen or irritant (eg, poison ivy). Vesicles/bullae may form in severe cases with weeping. The rash is usually limited to areas that encountered the allergen and is not contagious. Herpes Simplex Type 1: Erythema, Contagious, Crusted lesions, Tingling sensation, Blisters or vesicles -Herpes simplex virus type 1 (HSV-1) is a life-long viral infection with periods of dormancy and flares (often triggered by stress or illness). Initial infection may cause gingivostomatitis (ie, painful oral lesions), pharyngitis, lymphadenopathy, fever, and malaise. HSV-1 is most contagious during flares and clients may experience a recurrence of painful, erythematous, vesicular lesions around the mouth (ie, cold sores). Lesions frequently begin with an itching or tingling sensation (due to being dormant in dorsal nerve ganglia) and then rupture to form a crust. Impetigo: Erythema, Contagious, Crusted lesions,, Blisters or vesicles -Impetigo is a highly contagious bacterial infection of the skin that initially manifests as erythematous fluid-filled lesions (ie, vesicles [<1 cm] or bullae [>1 cm]) on exposed areas (eg, face, limbs). As the vesicles or bullae rupture, the characteristic honey-colored crust forms. Primary impetigo can develop in previously healthy skin; however, secondary impetigo (the most common form) usually occurs in areas where the skin barrier is already impaired (eg, eczema, abrasions)

The client is admitted for supportive management and observation. For each potential prescription, click to specify if the prescription is anticipated or not anticipated for the care of the client.

Anticipated: 1. Obtain daily weights 2. Initiate fluid restrictions - to decrease circulatory volume and edema, and prevent cardiopulmonary overload. Administer IV loop diuretics Not Anticipated: Maintain client on strict bed rest, Administer ibuprofen as needed for headache -Ibuprofen is not anticipated for clients at risk for acute kidney injury (AKI) because the antiprostaglandin action can further decrease the rate of glomerular filtration, increasing the risk of AKI. In addition, ibuprofen may decrease the effects of diuretics, worsening hypertension.

The nurse is reviewing the client's assessment data to develop the client's plan of care. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurses should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress Urinary tract infections (UTIs) can affect the upper urinary tract/kidney (ie, pyelonephritis) or lower urinary tract/bladder (ie, cystitis). The bacteria that cause most UTIs originate from fecal flora (eg, Escherichia coli) that ascends the urinary tract. Bacteria ascend to the bladder through the relatively short urethra in female clients, which is often facilitated by sexual intercourse. Pyelonephritis occurs when bacteria ascend through the ureters and reach the kidneys..

Potential Conditions: Pyelonephritis Actions To Take: Administer antibiotics, Obtain urine specimen for culture and sensitivity Parameters to Monitor: Blood pressure, Respiratory Rate Clinical manifestations of pyelonephritis include dysuria, fever, flank pain, costovertebral angle tenderness, nausea/vomiting, and urinary frequency. Complications can include sepsis and its related complications (acute respiratory distress syndrome, acute kidney injury). Nursing interventions for a client with suspected pyelonephritis include: - Obtaining a urine specimen for culture and sensitivity to identify the causative microorganism and most appropriate antibiotic choice - Administering antibiotics - Monitoring vital signs for indications of urosepsis or septic shock caused by worsening infection (eg, decreasing blood pressure, increasing respiratory rate) - Administering antipyretics (eg, acetaminophen) for fever and pain